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Can Emergency Department Patients Remove Their Own Non-absorbable Sutures at Home?

Three Part Question

What proportion of [adult patients with lacerations repaired in the emergency department] are [capable of successfully removing their non-absorbable sutures] at [home if provided suitable instructions and equipment] versus [the standard follow-up care]?

Clinical Scenario

25-year-old presents to the emergency department after sustaining a laceration to his ankle after cutting his leg on a piece of metal. The wound is hemostatic on presentation. There does not appear to be any gross contamination and a simple closure is adequate with nonabsorbable sutures. After closure the patient is given routine discharge instructions when he questions you about removing his sutures at home.

Search Strategy

Medline 1966-04/20 using PubMed, Cochrane Library (2020), and Embase
[(exp suture removal) OR (exp suture removal kit) OR (exp self-removal)]. Limit to English Language and clinical trials

[(exp sutures) AND (exp self care or exp self-removal)]. Limit to English Language and clinical trials

Search Outcome

134 clinical trials were identified; one addressed the clinical question.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Macdonald P, et al
July 2012
Canada
183 adults who presented to the ED with a laceration sutured using non-absorbable sutures. The study group was provided with wound care instructions, a suture removal kit, and instructions regarding suture self-removal. RCTProportion of patients successfully removing their own sutures91.5% of intervention group vs 62.8% control group removed own sutures Single blinded, pseudo-randomization, and no formal cost-benefit evaluation was conducted. Did not have the power to truly show if there are negative outcomes associated with self- suture removal and there was no verification of wound infection and dehiscence.
Visits to follow-up physician for wound carePatients visited their physician less often in the intervention group (9.8% vs 34.6%)
Complication rates No significant differences

Comment(s)

There is very little in the literature that assesses the willingness to, or rate at which patients remove their own sutures. Suture removal for uncomplicated or simple lacerations is relatively safe and easy. Clinicians should consider discharging patients with appropriate suture removal kits and instructions. These kits generally contain a sterile pair of scissors, forceps and a gauze sponge and are generally quite inexpensive. Patients should also be directed to look for signs of infection and instructed to see a physician or return to the ED should the experience any problems with their wound, or complications when removing sutures.

Clinical Bottom Line

The majority of ED patients with uncomplicated lacerations prefer to remove their own sutures. Clinicians should consider discharging patients with appropriate suture removal kits and instructions.

References

  1. Macdonald P, Primiani N, Lund A. Are patients willing to remove, and capable of removing, their own nonabsorbable sutures? CJEM 2012 Jul;14(4):218-23.